Afghanistan: following in the footsteps of Florence Nightingale

11-08-2010 Feature

A small woman, with a wide smile and soft grey hair, Anisa was awarded the Florence Nightingale Medal – the highest international distinction that can be given to a nurse or nursing aide – in 2009. She is the first Afghan to win the award.

Anisa receiving her Florence Nightingale Medal from Afghan Vice President Karim Kalili at his office in Kabul.

“I intend to go on helping the people of Afghanistan, especially my patients, until the end of my life,” remarks Anisa, a 59-year-old registered nurse and mother of nine, who, like many Afghans, uses only one name.

Born and raised in Kabul, Anisa trained at the city’s Nursing School and spent two years in the physiotherapy department of a large hospital before moving to the crowded, dusty city of Jalalabad near the Pakistan border with her second husband in 1981. Two years later, she began working at Jalalabad’s Public Health Hospital Number One – known as JPHH-1 – where she is still based.

At patients' side through thick and thin

Afghanistan has been mired in conflict for over thirty years, and much of Anisa’s time at JPHH-1 has been spent tending the wounded, often during active fighting. At one point, some years ago, when Taliban fighters overtook the hospital her superior advised her to stay at home, but she refused. “I will come to help the patients,” she remembers saying at the time.

On another occasion she was put in charge of a patient who was a detainee. “No one was allowed to go near him,” she recalls. “I was the only one given permission to look after him and take him his food.” Following his release, the patient, who became a high-ranking soldier, brought her a present of flour to express his gratitude.

Anisa worked in the female medical ward of JPHH-1 for more than 15 years, and became head nurse. She also spent time in the reanimation ward, and is currently seconded to the operating theatre.

Today, the hospital is more likely to receive mass casualties caused by a suicide bombing than by fighting.

Mentoring young nurses

Even before she was awarded the Florence Nightingale Medal, Anisa was something of an iconic figure, and a mentor to the younger nurses. “I tell everyone who wants to make a career in nursing that they must perform their duties with kindness,” she says, “and they must work hard to learn as much as they can, so they can serve the people who need their help.”

In contrast to Florence Nightingale, who had to struggle for years to gain her independence so she could follow her calling, Anisa’s loved ones, especially her brother, encouraged and supported her.

A woman's place

But there are also similarities between Anisa’s circumstances in Afghanistan and those of British-born Miss Nightingale a century-and-a-half earlier in the Crimea. Not the least of these was the attitude of English society in those days, which looked askance at women working in the medical field. Amongst Afghans today, in Pashto society in particular, a woman’s place is still considered to be in the home.

Florence Nightingale was famous not only for taking care of soldiers wounded on the battlefields around Scutari and Balaclava, but also for her pioneering work in public health.

In today’s Afghanistan, where insecurity and conflict are severely affecting people’s access to medical care – especially in rural areas – first aid, and simple measures of preventive health care such as attention to hygiene and proper sanitation are being taught at the community level and would certainly have met with Florence Nightingale’s approval.

Much of this work is being carried out by staff and volunteers of the Afghan Red Crescent Society, as well as by hygiene promotors working with the ICRC. It was the Afghan Red Crescent, supported by expatriate nurses working with the ICRC in Jalalabad, who nominated Anisa for the 2009 Florence Nightingale award.

There were 28 recipients of the medal that year, from countries as diverse as China, New Zealand, and Azerbaijan. The award stipulates that the presentation ceremony should be a formal affair, conducted, if possible, by the Head of State, the President of the Central Committee of the respective Red Cross or Red Crescent National Society, or their deputies.

Honouring determination, courage and compassion

During a short, dignified ceremony at his office in Kabul, Afghan Vice President, Karim Kalili presented Anisa with her medal as she stood surrounded by well wishers and her family. The same day she was honoured with a gathering at the headquarters of the Afghan Red Crescent.

Florence Nightingale died in 1910, at 90 years of age. Until the very end of her life she strove to improve the medical treatment of the war wounded, to raise standards in public health, and to enhance the status and training of nurses. Her efforts have never been forgotten, and she remains a symbol of altruism and selflessness to this day. It is perhaps fitting therefore, that in another age and in the midst of a very different conflict, an Afghan nurse should be honoured in her name for similar qualities of determination, courage and compassion.